Excellence is a hot-button word in health care advertising. But how can everyone lead the pack at the same time? And what parameters does the word address? Nicer lobby or fewer infections? Better TVs or better staffing? Find out why this should matter to patients and to corporate executives.

Some of you probably remember the old Ken-L-Ration commercial that had a kid singing, "My dog is better than your dog!" That's a popular refrain these days, only instead of pups and their chow, we're talking about whose hospital is better and whose staff is more excellent.

There's nothing wrong with excellence, per se. It's, pardon the expression, an excellent quality to strive for. But corporate lust for patient census combined with PR pandering has flogged that formerly good word until it doesn't mean much anymore.

"Excellent" comes from the word, "excel," which means to do or be better than everyone else. It's easy to see why the public relations folks have glommed onto a word that suggests superiority. But how accurate can these claims of excellence be if every health care facility in town insists that it leads the pack.

This reminds me of the flapdoodle over grade inflation that started back in the 1980s. A large and vocal contingent of parents foamed at the mouth if teachers didn't give their children straight A's. When teachers tried to explain the concept of the bell curve to them, they scoffed. You don't get into Stanford or Yale, they said, by making excuses.

The problem followed the wunderkind to their upper crust universities. It's statistically impossible for everyone to excel, but what do you tell earnest young undergrads and their folks when the entire class is made up of overachievers?

If the Ivy League struggles with this, so does the IV League. Just listen to the health care commercials in any major market, and you'll hear boasting that would put Nobel Prize winners' mothers to shame. I can almost see the CEOs posturing on the playground:
"We're truly excellent!"
"No way! We're excellenter!"
"We're excellentest!
"We're excellentest times infinity!"
"Yeah, well, we're excellentest times infinity plus one."

Oh, please. I get that each group wants to claim bragging rights as the coolest, most splendiferous health care delivery system in the history of the planet, but enough already.

Besides being as irritating as teething toddlers (and even less mature), the downfall of this kind of advertising is that it doesn't really mean anything. Unless you can tell me how your hospital or clinic leaves the competition behind--in terms that really matter--the rest is just hype.

The problem with this challenge is that flash is so much, well, flashier, than substance. Your newly-decorated lobby is lovely, but tell me about the success rate of the surgery I need. You have concierge service? Great. Do you follow recommended nurse/patient ratios? Valet parking is nice, especially if I'm in pain, but I'm more interested in your post-op infection rate.

Whichever health care entity gets wise to this and starts to mention more important parameters will put the rest on the defense. They can choose areas where they are actually doing well and challenge the others to put up or shut up.

If the PR gurus and the CFOs think that annoying nurses are the only ones who worry about the behind-the-scenes information and that Joe or Josephine down the block is happy enough to be dazzled by pictures of sunny patient pavilions and smiling docs, they might be surprised.

In just one example, the pharmaceutical companies of several decades ago spent buckets of money coming up with robust, impressive-sounding names for new meds. "If our med name has a good 'ear-feel'" they reasoned, "folks will choose it. And besides, nobody wants to mess with those sciency generic names." They may have had a point back then.

But as patients and their health insurance companies began to balk at pricier and pricier brand name prescriptions, generics became a lot more interesting. People were delighted to learn that generic meds proved to be nearly identical to the name brands, and they put this information to good use. Today, slick names notwithstanding, 75 percent of prescriptions written in the US are for generic meds.

Why hasn't some corporate ace figured out how to speak to people about things that matter more than nice decor and surface amenities? Because that would require paying attention to (and spending money on) things like hiring staff and fighting staph, i.e., better ratios, and fewer nosocomial infections. This would require teaching potential patients about why such things matter and what a particular facility is doing to achieve success in these areas.

But there's the rub. Health care dollars are shrinking. It's easier, more visible, and less expensive to install new curtains and flat screen TVs than it is to provide extra nurses and aides. Here's another sticking point, no one wants to speak of nasty things like hospital-transmitted diseases, even though every facility has to deal with them. The thing is that ignoring them doesn't mean they don't exist, and most people are smart enough to figure that out.

Eventually, some health care decision-maker is going to realize that, far from being dim bulbs, most consumers are both teachable and discerning. Given a choice between straight talk and hoopla, they'll consistently opt for the first one. That hospital/PR bigwig is going to build a terrific new ad campaign that will treat people with respect, educate them about what's really important, and show how they provide good outcomes along with the nice amenities. And they'll be very pleased with the results.

It wouldn't surprise me if this upper-level executive started out his or her career as a nurse.

Very well said. It is much more appealing to tout beautiful new facilities with waterfalls and flat screens than to show actual statistics. The never ending dualing billboards are nauseating.

Dec 8, '11

We won the Missouri quality award in 2010 and I think 2007. In 08 or 09, a hospital in the next town won it and put up a billboard right in front of our hospital. Ridiculous, I said. First of all, it's a business leadership award as opposed to a healthcare quality award. Fine, I see what is important. We just got new flatscreens in every room. Who gives a flying $&*!. I got a 1.88% raise last year. Maybe that paid for one of those TVs. and I still have 7:1 patient ratios. We censor our speech so that our Press Ganey Surveys will trigger a positive memory. Maybe if we had proper staffing and training and better communication with doctors, there would be better and better outcomes. Who cares how many abdominal surgical patients ended up with an ileus or on stepdown with afib RVR because their meds weren't continued for days. Their family memebr got coffee with three creamers every morning. It doesn't matter if they got good care, they just have to think they did.

Dec 8, '11

I had to delete my entire post of what I really thought.

Dec 8, '11

it is so easy for a hospital to set all kinds of ridiculous standards that can never be practiced because of ratios. if you talk the talk you better be able to walk the walk. unfortunately most cno's and/or cfo's have no idea what goes on nursing units daily.

Dec 8, '11

WTH is a center of excellence anyway? To me they call themselves excellent just for doing what they should be doing. And the public really doesn't buy it anyway.

I think that they use buzzwords to avoid addressing the cause of complications such pressure ulcers, falls, VAPs, BSI's, surgical site infections.

Those causes being inadequate staffing and bad medicine.

I would like to work at a hospital that publishes their Nurse Patient ratios, mortality and morbity reports. Forget the glossy brochures, tell me the infection rates for a TKR or CABG. I want to know how many hospitalists cover the house at night. I want to know how many nurses hold certification in their specialty areas and how are they compensated for that credential (I get nothing for my CCRN).

But if they told the truth now no one would want to go there, would they?

Dec 8, '11

NayRN, you said it all:

"It doesn't matter if they got good care, they just have to think they did.

Jan 2, '12

I'd like to copy this entire article and send it to my UM. Would you mind if I did that?

You have an amazing way of putting down coherently and concisely exactly the message I want to get across to management.

Jan 2, '12

I would be happy to have you pass the article along to your UM. Thank you for your encouraging words.

I'd love to hear the UM's reaction.

Jan 2, '12

Interesting - a local hospital brags on huge billboards all over town that a patient gets "seen" in 30 minutes or your care is free. Of course "seen" means triaged by a nurse and the public thinks it means seen by a physician.

I was visiting my fil a few months ago when he had gallbladder surgery and the rooms were amazing. The TV's were on this long arm that could be pushed up out of the way into a corner or brought right to eye level within inches of the patient's face. But the CNA's and Ward Clerks were still scarce. Since the ratio law, RN's are pretty much alone on the job.

I don't know how to fix things - you pass a ratio law and then other staff gets cut to pay for more RN's.

Interesting - a local hospital brags on huge billboards all over town that a patient gets "seen" in 30 minutes or your care is free. Of course "seen" means triaged by a nurse and the public thinks it means seen by a physician.

I was visiting my fil a few months ago when he had gallbladder surgery and the rooms were amazing. The TV's were on this long arm that could be pushed up out of the way into a corner or brought right to eye level within inches of the patient's face. But the CNA's and Ward Clerks were still scarce. Since the ratio law, RN's are pretty much alone on the job.

I don't know how to fix things - you pass a ratio law and then other staff gets cut to pay for more RN's.

This is the essence of my particular beef; no service-orientated business can function without sufficient staff to perform the actual service. It might be argued that any hospital that advertises top quality care, yet provides inadequate staff to perform that care, is guilty of misleading advertising, but accuse them and they'll probably plead "nursing shortage".

The bulk of "nursing" care is actually basic care, and does not require a qualified nurse to perform it. By taking away the lower echelons in favor of RNs, the hospitals only put a greater burden on their qualified staff, and a lower standard of care on their patients. The fact is that they really do not care about the patients, only the money brought in by them.